Docosahexaenoic Acid for Reading, Cognition and Behavior in Children Aged 7–9 Years: A Randomized, Controlled Trial (The DOLAB Study)

Centre for Evidence-Based Intervention, University of Oxford, Oxford, United Kingdom.
PLoS ONE (Impact Factor: 3.23). 09/2012; 7(9):e43909. DOI: 10.1371/journal.pone.0043909
Source: PubMed


Omega-3 fatty acids are dietary essentials, and the current low intakes in most modern developed countries are believed to contribute to a wide variety of physical and mental health problems. Evidence from clinical trials indicates that dietary supplementation with long-chain omega-3 may improve child behavior and learning, although most previous trials have involved children with neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD) or developmental coordination disorder (DCD). Here we investigated whether such benefits might extend to the general child population.
To determine the effects of dietary supplementation with the long-chain omega-3 docosahexaenoic acid (DHA) on the reading, working memory, and behavior of healthy schoolchildren.
Parallel group, fixed-dose, randomized, double-blind, placebo-controlled trial (RCT).
Mainstream primary schools in Oxfordshire, UK (n = 74).
Healthy children aged 7-9 years initially underperforming in reading (≤33(rd) centile). 1376 invited, 362 met study criteria.
600 mg/day DHA (from algal oil), or taste/color matched corn/soybean oil placebo.
Age-standardized measures of reading, working memory, and parent- and teacher-rated behavior.
ITT analyses showed no effect of DHA on reading in the full sample, but significant effects in the pre-planned subgroup of 224 children whose initial reading performance was ≤20(th) centile (the target population in our original study design). Parent-rated behavior problems (ADHD-type symptoms) were significantly reduced by active treatment, but little or no effects were seen for either teacher-rated behaviour or working memory.
DHA supplementation appears to offer a safe and effective way to improve reading and behavior in healthy but underperforming children from mainstream schools. Replication studies are clearly warranted, as such children are known to be at risk of low educational and occupational outcomes in later life. NCT01066182 and ISRCTN99771026.

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    • "Results from several studies have shown that PUFA increases fasting glucose concentrations in people with type 2 diabetes mellitus and control groups (37–39) and that this might occur by decreasing the sensitivity of pancreatic β-cells to glucose (40). The satisfactory safety profile in several studies in adults and children (14, 27, 28) and its status as a food supplement makes fish oil-derived PUFA an attractive treatment adjunct to achieve greater glycemic stability in children with CHI. In our study, the primary objective of increased glycemic response was not achieved and the extent of glucose increment observed was lower than hypothesized in the trial protocol. "
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    ABSTRACT: Objective: Congenital hyperinsulinism (CHI) is a rare condition of hypoglycemia where therapeutic options are limited and often complicated by side-effects. Omega-3-polyunsaturated fatty acids (PUFA), which can suppress cardiac myocyte electrical activity, may also reduce ion channel activity in insulin-secreting cells. PUFA supplements in combination with standard medical treatment may improve glucose profile and may reduce glycemic variability in diazoxide-responsive CHI. Design: Open label pilot trial with MaxEPAR liquid (eicosapentaenoic and docosahexaenoic acid) PUFA (3 ml/day for 21 days) in diazoxide-responsive CHI patients (, EudraCT number 201100363333). Methods: Glucose levels were monitored pre-treatment, end of treatment, and at follow-up by subcutaneous continuous glucose monitoring systems (CGMS) in 13 patients (7 girls) who received PUFA. Outcome measures were an improved glucose profile, reduced glycemic variability quantified by a reduction in the frequency of glucose levels <4 and >10 mmol/l, and safety of PUFA. All children were analyzed either as intention to treat (n = 13) or as per protocol (n = 7). Results: Mean (%) CGMS glucose levels increased by 0.1 mmol/l (2%) in intention to treat and by 0.4 mmol/l (8%) in per protocol analysis (n = 7). The frequency of CGMS <4 mmol/l was significantly less at the end of treatment than in the pre-treatment period [556 (7%) vs. 749 (10%)]. Similarly, the frequency of CGMS >10 mmol/l, was also less at the end of treatment [27 (0.3%) vs. 49 (0.7%)]. Except for one child with increased LDL cholesterol, all safety parameters were normal. Conclusion: MaxEPAR was safe and reduced glycemic variability, but did not increase glucose profiles significantly in diazoxide-responsive CHI. The supplemental value of PUFA should be evaluated in a comprehensive clinical trial.
    Frontiers in Endocrinology 03/2014; 5:31. DOI:10.3389/fendo.2014.00031
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    • "(Cohen's d=−0.343) (Richardson et al., 2012). "
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    ABSTRACT: Sleep problems in children are associated with poor health, behavioural and cognitive problems, as are deficiencies of long-chain omega-3 fatty acids such as docosahexaenoic acid. Theory and some evidence support a role for these fatty acids in sleep regulation, but this issue has received little formal investigation. We examined associations between blood fatty acid concentrations (from fingerstick blood samples) and subjective sleep (using an age-standardized parent questionnaire) in a large epidemiological sample of healthy children aged 7–9 years (n = 395) from mainstream UK schools. In a randomized controlled trial, we then explored whether 16-week supplementation (600 mg day−1) with algal docosahexaenoic acid versus placebo might improve sleep in a subset of those children (n = 362) who were underperforming in reading. In a randomly selected subsample (n = 43), sleep was also assessed objectively via actigraphy. In 40% of the epidemiological sample, Child Sleep Habits Questionnaire scores indicated clinical-level sleep problems. Furthermore, poorer total sleep disturbance scores were associated weakly but significantly with lower blood docosahexaenoic acid (std coeff. −0.105*) and a lower docosahexaenoic acid : arachidonic acid ratio (std coeff. −0.119**). The treatment trial showed no significant effects on subjective sleep measures. However, in the small actigraphy subsample, docosahexaenoic acid supplementation led on average to seven fewer wake episodes and 58 min more sleep per night. Cautiously, we conclude that higher blood levels of docosahexaenoic acid may relate to better child sleep, as rated by parents. Exploratory pilot objective evidence from actigraphy suggests that docosahexaenoic acid supplementation may improve children's sleep, but further investigations are needed.
    Journal of Sleep Research 03/2014; 23(4). DOI:10.1111/jsr.12135 · 3.35 Impact Factor
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    • "Daily intakes of DHA (from fish, enriched foods, and supplements) of 200–250 mg·day –1 would most likely provide such levels of DHA in breast milk. Recently, Richardson et al. (2012) reported a highly significant improvement in reading ability scores when schoolchildren (ages 7–9 years), who were initially in the lower 10th or 20th percentiles with respect to reading ability, received daily DHA supplementation (600 mg·day –1 ) over 16 weeks relative to the placebo group. Numerous systematic reviews and meta-analyses based on randomized clinical trials as reported in peer-reviewed medical journals have been published during the past decade on DHA– EPA omega-3 fatty intakes (via diet and supplementation) and cardiovascular-related outcomes. "
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    ABSTRACT: The science of lipid research continues to rapidly evolve and change. New knowledge enhances our understanding and perspectives on the role of lipids in health and nutrition. However, new knowledge also challenges currently held opinions. The following are the proceedings of the 2013 Canadian Nutrition Society Conference on the Advances in Dietary Fats and Nutrition. Content experts presented state-of-the-art information regarding our understanding of fish oil and plant-based n-3 polyunsaturated fatty acids, nutrigenomics, pediatrics, regulatory affairs, and trans fats. These important contributions aim to provide clarity on the latest advances and opinions regarding the role of different types of fats in health.
    Applied Physiology Nutrition and Metabolism 01/2014; 39(7). DOI:10.1139/apnm-2013-0418 · 2.34 Impact Factor
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